Biomedical subjects
Publications and source records attributed to K Zukowsky.
Advanced ventilation therapies for the sick neonate, such as nitric oxide and liquid ventilation, may be effective in treating the sick neonate. Both techniques are discussed in terms of their current merit for treatment and what impact they may have on nurses caring for the sick neonate.
Accurate monitoring of respiratory status is of vital importance for the bedside nurse caring for the critically ill neonate. Pulmonary function testing can be utilized to effectively diagnose and quantitate lung disease in infants. Data obtained can be integrated into the nursing assessment and facilitate appropriate nursing interventions. The case studies provided in Part III of this series illustrate the utility of such testing in neonates with a range of illnesses and different diagnostic and therapeutic dilemmas. Case study one is an infant with chronic lung disease complicated by bronchospasm, case study two is an infant with bronchomalacia, and case study three demonstrates fine tuning of the ventilator in an infant with respiratory distress syndrome. Every study describes the usefulness of pulmonary function testing on a specific patient, each with different pulmonary pathology. These case studies, and the discussion in parts I and II of this series, illustrate the value of integrating pulmonary function data with ongoing clinical assessment to optimize the care of the sick or convalescing neonate. Tests ordered on a routine and/or as-needed basis will provide detailed information on the infant's pulmonary status that may be readily available at the infant's bedside. The neonatal nurse's involvement in requesting, performing, and interpreting these tests may enhance the treatment of the infant in intensive care.
Respiratory insufficiency, a frequent problem encountered by the critically ill neonate, has many etiologies. Pulmonary function testing can effectively diagnose, quantify, and qualify the dysfunction so as to better define a prognosis and guide appropriate therapy. Recent advances in computer-assisted technology and miniaturization of equipment now allow simple, reproducible, and rapid neonatal pulmonary function assessment at the bedside. The indications for, and benefits of, pulmonary function testing vary with gestation, age, and clinical condition of the infant. The overall description of the pulmonary function profile is discussed in this article. The general questions and approaches utilized for routine testing, the initial pulmonary function profile, and evaluation of the acutely ill infant and that of the convalescing preterm are addressed. The expertise of the intensive care nurse is invaluable in ensuring that safe, accurate, and reproducible data are obtained. The nurse can then use the data to alter the infant's care plan and to determine the necessity and timing for retesting. Specific information on methodology and examples of specific tests are given in related articles (Parts II, Vol. 13 No. 2 and III, Vol. 13 No. 4, respectively). A complete knowledge of pulmonary function assessment is important for any nurse caring for critically ill neonates.
Pulmonary function testing is an important diagnostic tool in neonatal intensive care. These tests provide a detailed assessment of an infant's pulmonary status that can be used in several ways: to monitor the progression of lung disease, to streamline ventilator management, and to assess the infant's response to new treatments, such as surfactant replacement therapy or bronchodilators. In some settings, these tests are performed by specially trained nurses, and the results are available immediately for planning nursing care. This relatively noninvasive and low-risk assessment can be performed on all infants, whether on mechanical ventilation or breathing spontaneously. A comprehensive pulmonary function evaluation can be performed at the bedside in less than 60 minutes and is generally well tolerated. In this article, the determination of pulmonary "vital signs" tidal volume, minute ventilation, respiratory rate, pulmonary compliance, resistance, resistive work of breathing, and functional residual capacity-are discussed. The esophageal balloon technique for measuring dynamic pulmonary mechanics and energetics, as well as the helium dilution technique for measuring functional residual capacity, are described.
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A neonatal nurse practitioner (NNP) serves as the primary-care provider for in-hospital neonates. These practitioners receive different education and formal training than other nurse practitioners. The NNP's responsibilities may include managing patient care in an intensive-care unit, conducting normal newborn assessments and physical examinations, and providing high-risk follow-up visits. Career stressors, job satisfaction, and salaries vary among NNPs. The authors describe the variation in education and roles in this expanded nursing practice.
To provide more comprehensive follow-up care for low birthweight infants, it is important for nurses to know what concerns mothers of these low birthweight infants commonly experience and how concerns change over time. This descriptive, longitudinal study followed 65 mothers of low birthweight infants from birth until the infant was 6 months adjusted gestational age. Most concerns were raised the week following birth (109) and after infant discharge (72), although from 40 weeks (62) to 6 months (40), the number of concerns raised were fairly consistent. The largest category of concerns was health related (253).
The sucking patterns of 42 healthy full-term and 44 preterm infants whose gestational age at birth was 30.9 +/- 2.1 weeks were compared using the Kron Nutritive Sucking Apparatus for a 5-minute period. The measured pressures were used to calculate six characteristics of the sucking response: maximum pressure generated, amount of nutrient consumed per suck, number of sucks per episode, the duration or width of each suck, the length of time between sucks, and the length of time between sucking episodes. The maximum pressure of the term infant (100.3 +/- 35) was higher, p less than .05, than the maximum pressure of the preterm infant (84 +/- 33). Term infants also consumed more formula per suck (45.3 +/- 20.3 vs. 37.6 +/- 15.9, p less than .05). In addition, they had more sucks/episode (13.6 +/- 8.7 vs. 7.7 +/- 4.1, p less than .001) and maintained the pressure longer for a wider suck width (0.49 +/- 0.1 vs. 0.45 +/- 0.08, p less than .05). Sucking profiles of the preterm infant are significantly different from the full-term infant. These sucking profiles can be developed as a clinically useful tool for nursing practice.
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